Wednesday, December 9, 2009

More accurate method of screening for cervical cancer

Now that our government has taken the initiative to provide free Cervical Cancer Vaccine to school children, i felt happy that the Ministry of Health recognize the need to take action against this number 2 killer among Malaysian women. I felt disappointed that doctors are not taking their time explaining the need, implication, protection rate ,screening method, and many more related to the vaccination and follow up on the screening as such.
Its rather unfortunate to know that most doctors in Malaysia in the private sector are still using the conventional "Pap smear" for screening for cervical carcinoma.
Have you heard of stories of patients who regularly goes for their annual pap smear and was told to be normal, but died after a few months? ......due to cervical cancer?
Do you know that false negative results (which means patient has cancer or pre cancerous lesion but was not detected by conventional pap smear) is between 10%-50%!

The above two pictures are the conventional Pap smear kit, where by using a spatula inserted into the vagina until the end of the wooden spatula touches the cervix, a rotatory movement to get samples from the surface of the cervix.
However, the high false negative result is due to missed or inadequate sample collection from the endocervix.(the deeper part of the cervix).
Thin prep pap smear is an improvised version of Pap Smear.
Thin prep pap smear was introduce back in 1996, and currently being widely used in the US where conventional Pap Smear is almost obsolete. In view of the faulty collection of samples and high percentage of misinterpretation of the result, Thin Prep was designed to solve the problem.

Unlike conventional Pap Smear, where the samples are fixed on a slide, the sample collected from Thin Prep are placed in a solution medium.
As Pap smear's result is purely based on human's ability to detect the abnormal cell, Thin Prep undergoes two process instead. First, they would be subjected to a Thin Prep imaging, where a computer will scan through the sample to look for presence of abnormal cells. Upon completion of the first step, then a review by experienced pathologist to confirm the finding.
As you can see, the designed of the collection brush for Thin Prep pap smear is designed differently (on the right) where the central longer bristles are made to reach the endocervix, while the peripheral outer shorter ones are for the ectocervix.
This enable Thin Prep sample collection to be far more efficient and a more complete sampling obtained.

Hence whenever you are going for your routine check up, be sure to ask for Thin Prep Pap smear instead. It is surprising to know not many general practitioner do not know about the availability of such improvised Pap smear.
In conclusion, insist on Thin Prep method to prevent the possibility of a false negative. It gives a more accurate for diagnosing intraepithelial lesions, higher degree of accuracy detecting high grade lesions in the genital tract, decreased number of misinterpretations of Pap results, improved sample collection noted with use of Thin Prep preparation, amd the same sample can be used to test for other problems and disease including HPV and sexually transmitted diseases without having need to collect another sample.